An Interesting Case History of Intervertebral Disc Fenestration

Sarah Key's Account of what happened to her Own back!

For someone 'in the business' this was a sobering experience. To be crippled by pain and unable to sit or walk was indeed a crisis. How could this have happened to me? No previous back problems to speak of, and a back-treating specialist to boot!

Here's the story, The Downfall and The Cure

As I have so often heard from my patients, the lead-up to this crisis was nothing out of the ordinary. No one single precipitating incident. Rather a series of small events; running to catch a train hauling a heavy suitcase, a soft bed while away travelling, working too hard, too many things on; family matters, moving house after 30 years, a staff crisis at work and so on. Previous fractures of transverse processes at L1 and L2 through a horse-riding fall 20 years earlier . . . .

But from no pain, there appeared a nasty pinching pain in my right mid-lower back that was difficult to budge. Over a period of a week it worsened inexorably. The most striking feature was a complete inability to sit. Things came to a head during a long walk carrying shopping, with a jangling pain down my right leg which seemed as if live wires were touching. By the end of the walk I could barely take another step.

I then spent 4 days lying on the floor by day and sleeping at night. (It was then that I realised anew the importance of a hard bed. It made ALL the difference). I was not in pain lying down.

L5 disc prolapse (fenestration)

When I eventually had an MRI it was quite a shock. It showed a fenestrated (sequestrated or burst) disc at L5 with quite marked degenerative changes throughout my spine.

My L4 spinal segment looked, well, horrible. There was also quite marked modic changes in the vertebral bodies of L4 and L5 with loss of disc height and osteophyte formation.

At no point did I have any neurological signs. I had pretty well full straight leg raise (SLRs) both sides. Duller right ankle jerk (AJ) reflexes only came on later, as did reduced tone of the right calf. All throughout, I could bend and move freely in all directions. I just couldn’t sit.

In the 2 week aftermath I had transient atrophy of my right calf muscles, so walking for any length of time was difficult. The good news is that 2 weeks later I was back to 100%. Now, all OK. No pain. Zero.

What seemed like a nightmare was soon over - I assume, and I'm pleased to say, through my own techniques of spinal decompression and appeasing exercise. BUT that came later. First I needed bed-rest and medication.

See disc matter compressing the nerve root

The Cure took 2 weeks, so How did I fix my own back?

1. Not panicking

2. Proper medication - some would say over the top, with one week of narcotics (pain), steroids (anti-inflammatory) and Valium (muscle relaxation and sleep ++). (Incidentally, I found the Cox2 inhibitor drugs messed with my mind and gave me very black thoughts. I took one tablet and stopped.)

3. A firm bed, either the mattress on the floor (asking hotels to provide a bed board under the mattress)

4. Sustained spinal rotations

5. Spinal appeasing techniques

6. My own hands-on treatment, tinkering about with my fingers - though the angles are awkward. You can see a video of me doing this called 'Back Pain Videos for The Time Poor'

7. Resuming the BackBlock after 2 weeks

8. A pillow behind my back when sitting

Here are those simple Spinal Self-Treatment techniques

SUSTAINED LUMBAR SPINE ROTATIONS

Technique: Lying relaxed with legs resting twisted to the left (for right leg symptoms), the upper back remaining as flat on the floor as possible, for up to five minutes every 2 hours. Repeated during the 4 day period of bed rest on the floor.

Rationale: To open the spine on the right side at several lumbar levels to speed the absorption of extruded disc material by the blood supply.

KNEES ROCKING EXERCISE

Technique: Ankles crossed, one hand cupped over each knee, knees wide. Small amplitude rocking the knees at a rate of approximately one cycle/second; a soothing repetitive rhythm, for 2 minutes. Repeat every 2 hours, or if the pain has intensified (by sitting).

Rationale: To pump more blood through the area. To ease protective muscle spasm to help the back relax, easing the lumbar spinal segments apart. See 'Get Out of Pain' videos.

SELF SPINAL MOBILISING WITH THE HANDS

Technique: Gentle fingertip pressures from the middle and index fingers against the L2,3 spinous processes from R to L. Continued for 60 seconds once per day.

Rationale: To put my consciousness in contact with the problem by touching the pain. To ease the affected spinal segments apart through softening the protective clench of the spinal muscles. See 'Time Poor' videos below.

The spinal appeasing techniques to ease myself out of crisis were exactly as shown here in these video clips, persevering with each exercise, as you will see me doing, until I was out of pain. They were repetitive and calming; less is more.

So, what do i think happened here?

I think my primary and originating problem was an acute facet strain at L2-3. This created all the back pain, focused in the right mid-lower lumbar area. (One of my own trained physios saw me and felt it was ‘high lumbar right with nothing much at L5’.) Despite the scans, the symptoms from the disc fenestration in the right leg were few and soon gone.

I believe at the peak of the crisis (driving on an autostrada in Italy and unable to pull over) the muscle spasm caused by L2-3 was so intense 'the muscles with a mind of their own’ that it burst a fairly healthy L5 disc lower down. I was unable to stop the spasm as I drove. Excruciatingly painful, but not from L5.

OBSERVATIONS

I was surprised by the sudden onset and the ferocity of the pain.

I was surprised by my inability to cope with the pain and the inadequacy of over-the-counter medication (4hrly Nurofen).

I was surprised how quickly I felt a nuisance to the family!

I was un-nerved by how quickly my thoughts veered towards surgery (despite my own advice in the new Kindle eBook 'Be Careful of Back Surgery' see below).

All information contained on this website is provided by Sarah Key Global (Australia) Pty Ltd.All information provided is intended to be of general application only and not specific to any particular person.For specific advice, you should consult a physiotherapist or other healthcare provider.